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\n\tAt a Glance:<\/strong><\/p>\n Things to know and remember:<\/p>\n What is diabetic eye disease?<\/strong><\/p>\n Diabetic eye disease is a group of eye conditions that can affect people with diabetes.<\/p>\n Diabetic retinopathy is the most common diabetic eye disease. Diabetic retinopathy affects blood vessels in the light-sensitive tissue called the retina that lines the back of the eye. It is the most common cause of vision loss among people with diabetes and the leading cause of vision impairment and blindness among working-age adults.<\/p>\n Diabetic macular edema (DME). A consequence of diabetic retinopathy, DME is the build-up of fluid (edema) in a region of the retina called the macula. The macula is important for the sharp, straight-ahead vision that is used for reading, recognizing faces, and driving. DME is the most common cause of vision loss among people with diabetic retinopathy. About half of all people with diabetic retinopathy will develop DME. Although it is more likely to occur as diabetic retinopathy worsens, DME can happen at any stage of the disease.<\/p>\n Diabetic eye disease can also include cataract and glaucoma. Adults with diabetes are 2-5 times more likely than those without diabetes to develop cataract. Cataract also tends to develop at an earlier age in people with diabetes. With glaucoma, diabetes nearly doubles the risk of glaucoma in adults.<\/p>\n All forms of diabetic eye disease have the potential to cause severe vision loss and blindness. That’s why early diagnosis and treatment are always the best options for diabetic patients. In fact, because diabetic eye disease often goes unnoticed until vision loss occurs, people with diabetes should get a diabetic eye exam at least once a year.<\/p>\n\t\t\tWhat are the types of diabetic retinopathy?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t There are generally two stages of diabetic retinopathy: Nonproliferative and proliferative. Nonproliferative diabetic retinopathy (NPDR), the most common type of diabetic retinopathy, occurs when the blood vessels in a person’s retina weaken and tiny bulges protrude from their walls. Proliferative diabetic retinopathy (PDR) is the more severe type of diabetic retinopathy and occurs with the growth of abnormal blood vessels. This may lead to bleeding or scar tissue formation, possibly causing detachment of the retina and permanent vision loss. Both NPDR and PD can cause diabetic macular edema (DME) which can cause central vision loss.<\/p>\n\t\t\tWho is at risk for diabetic retinopathy?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t Diabetic retinopathy can develop in anyone who has Type 1 or Type 2 diabetes. The longer a person has diabetes, and the less controlled the blood sugar is, the more likely that person is to develop this disease. Between 40 and 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy, although only about half are aware of it. Women who develop or have diabetes during pregnancy may have rapid onset or worsening of diabetic retinopathy. Although it may cause no symptoms at all or mild vision problems, one must not forget that diabetic retinopathy can still result in blindness and must be treated.<\/p>\n\t\t\tWhat causes diabetic retinopathy?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t Chronically high blood sugar from diabetes is associated with damage to the tiny blood vessels in the retina, leading to diabetic retinopathy. The retina detects light and converts it to signals sent through the optic nerve to the brain. Diabetic retinopathy can cause blood vessels in the retina to leak fluid or hemorrhage (bleed), distorting vision. In its most advanced stage, new abnormal blood vessels proliferate (increase in number) on the surface of the retina, which can lead to scarring and cell loss in the retina.<\/p>\n Diabetic retinopathy may progress through four stages:<\/p>\n What are the symptoms?<\/strong><\/p>\n The early stages of diabetic retinopathy usually have no symptoms. The disease often progresses unnoticed until it affects vision. Bleeding from abnormal retinal blood vessels can cause the appearance of “floating” spots. These spots sometimes clear on their own. But without prompt treatment, bleeding often recurs, increasing the risk of permanent vision loss. If diabetic macular edema (DME) occurs, it can cause blurred vision.<\/p>\n\t\t\tHow are diabetic retinopathy and DME detected?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t Diabetic retinopathy and DME are detected during a comprehensive dilated eye exam that includes:<\/p>\n Optical coherence tomography (OCT). This technique is similar to ultrasound but uses light waves instead of sound waves to capture images of tissues inside the body. OCT provides detailed images of tissues that can be penetrated by light, such as the eye.<\/p>\n A comprehensive dilated eye exam allows the doctor to check the retina for:<\/p>\n If DME or severe diabetic retinopathy is suspected, a fluorescein angiogram may be used to look for damaged or leaky blood vessels. In this test, a fluorescent dye is injected into the bloodstream, often into an arm vein. Pictures of the retinal blood vessels are taken as the dye reaches the eye.<\/p>\n\t\t\tHow can people with diabetes protect their vision?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t Vision lost to diabetic retinopathy is sometimes irreversible; however, early detection and treatment can reduce the risk of blindness by 95 percent. Because diabetic retinopathy often lacks early symptoms, people with diabetes should get a comprehensive dilated eye exam at least once a year. People with diabetic retinopathy may need eye exams more frequently. Women with diabetes who become pregnant should have a comprehensive dilated eye exam as soon as possible. Additional exams during pregnancy may be needed.<\/p>\n Studies such as the Diabetes Control and Complications Trial (DCCT) have shown that controlling diabetes slows the onset and worsening of diabetic retinopathy. DCCT study participants who kept their blood glucose level as close to normal as possible were significantly less likely than those without optimal glucose control to develop diabetic retinopathy, as well as kidney and nerve diseases. Other trials have shown that controlling elevated blood pressure and cholesterol can reduce the risk of vision loss among people with diabetes.<\/p>\n Treatment for diabetic retinopathy isaimed at treating diabetic retinopathy and diabetic macular edema. Comprehensive dilated eye exams are needed more frequently as diabetic retinopathy becomes more severe. People with more severe retinopathy require more frequent monitoring which will be individualized by your eye care provider..<\/p>\n What are my treatment options?<\/strong><\/p>\n Treatment options depend upon the nature of the diabetic eye disease but can include medications, laser, and sometimes surgery.<\/p>\n If early nonproliferative diabetic retinopathy is present, treatment of the eye may not be necessary if blood sugar is well maintained. If severe nonproliferative or proliferative diabetic retinopathy is present, laser procedures, surgeries, or injectable medications are available and may reverse, slow, or stop the progression of diabetic retinopathy.<\/p>\n Based on your vision diagnosis during examination, our diabetic eye care specialists will discuss with you the most appropriate treatment options.<\/p>\n\t\t\tHow is proliferative diabetic retinopathy (PDR) treated?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t For decades, PDR has been treated with scatter laser surgery, sometimes called panretinal laser surgery or panretinal photocoagulation. Treatment involves making 1,000 to 2,000 tiny laser burns in areas of the retina away from the macula. These laser burns are intended to cause abnormal blood vessels to shrink. Although treatment can be completed in one session, two or more sessions are sometimes required. While it can preserve central vision, scatter laser surgery may cause some loss of side (peripheral), color, and night vision. Scatter laser surgery works best before new, fragile blood vessels have started to bleed. Recent studies have shown that anti-VEGF treatment not only is effective for treating DME, but is also effective for slowing progression of diabetic retinopathy, including PDR, so anti-VEGF is increasingly used as a first-line treatment for PDR.<\/p>\n\t\t\tWhen do patients with diabetic retinopathy need surgery?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t In some cases of proliferative diabetic retinopathy (PDR), the new blood vessels can cause severe bleeding called a vitreous hemorrhage. This bleeding can block the vision and block the ability of your eye doctor to perform laser treatments. Further, neovascularization can lead to retinal detachment putting the patient at risk for severe vision loss. In these cases, your retinal specialist may recommend surgery to remove the blood or repair the retinal detachment.<\/p>\n\t\t\tWhat is Laser Treatment for Nonproliferative Diabetic Retinopathy?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t In nonproliferative diabetic retinopathy (NPDR), leaking blood vessels can cause diabetic macular edema (DME) and loss of vision. The goal of laser for DME in NPDR is to stop the leakage and prevent further vision loss. In some cases of severe NPDR, peripheral laser is used to prevent the development of proliferative retinopathy.<\/p>\n\t\t\tWhat about Laser Treatment for Proliferative Diabetic Retinopathy?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t If the number of new vessels is great, laser treatment can often prevent loss of vision. The type of laser treatment that is done when there are a lot of vessels is called Panretinal Photocoagulation. This type of laser treatment is usually done in two or more separate sessions. The idea is to use the laser to destroy all of the dead areas of the retina where the blood vessels have been closed. When these areas are treated with the laser, the retina stops manufacturing new blood vessels, and those that are already present tend to diminish or disappear.<\/p>\n Panretinal photocoagulation may have side effects and does not usually improve vision; it is a means of holding vision stable to prevent further loss. After laser treatments, patients may still have reduced vision or may continue to lose more vision. But if laser is indicated, the chance is that laser treatment will prevent severe loss of vision.<\/p>\n Panretinal photocoagulation is placed in the periphery of the retina, not the center, and side vision may be diminished. These peripheral areas are treated in order to save as much of the central vision as possible and to save the eye itself. Night vision may also be diminished. After laser, blurred vision is very common. Usually this blur goes away but in a small number of patients, some blur may continue forever.<\/p>\n\t\t\tHow is DME treated?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t DME can be treated with several therapies that may be used alone or in combination.<\/p>\n Anti-VEGF Injection Therapy.<\/strong> Anti-VEGF drugs are injected into the vitreous gel to block a protein called vascular endothelial growth factor (VEGF), which can stimulate abnormal blood vessels to grow and leak fluid. Blocking VEGF can reverse abnormal blood vessel growth and decrease fluid in the retina. Available anti-VEGF drugs include Avastin (bevacizumab), Lucentis (ranibizumab), and Eylea (aflibercept). Lucentis and Eylea are approved by the U.S. Food and Drug Administration (FDA) for treating DME. Avastin was approved by the FDA to treat cancer, but is commonly used to treat a variety of eye conditions, including DME and severe diabetic retinopathy.<\/p>\n Avastin, Lucentis, and Eylea vary in cost and in how often they need to be injected, and treatment will be individualized to the patient.<\/p>\n Focal\/grid macular laser surgery.<\/strong> In focal\/grid macular laser surgery, small laser burns are made to leaking blood vessels in areas of edema near the center of the macula. Laser burns for DME slow the leakage of fluid, reducing swelling in the retina. The procedure is usually completed in one session, but some people may need more than one treatment. Focal\/grid laser may be used with or without anti-VEGF injections.<\/p>\n Corticosteroids.<\/strong> Corticosteroids, either injected or implanted into the eye, may be used alone or in combination with other drugs or laser surgery to treat DME. The Ozurdex (dexamethasone) implant is for short-term use, while the Iluvien (fluocinolone acetonide) implant is longer lasting. Both release a sustained dose of corticosteroids to suppress DME. Corticosteroid use in the eye increases the risk of cataract and glaucoma. DME patients who use corticosteroids should be monitored for increased pressure in the eye and glaucoma.<\/p>\n\t\t\tWhat is a vitrectomy?<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t A vitrectomy is the surgical removal of the vitreous gel in the center of the eye. The procedure is used to treat severe bleeding into the vitreous, and is performed under local or general anesthesia. Ports (temporary water-tight openings) are placed in the eye to allow the surgeon to insert and remove instruments, such as a tiny light or a small vacuum-cutter called a vitrector. A clear salt solution is gently pumped into the eye through one of the ports to maintain eye pressure during surgery and to replace the removed vitreous or blood from diabetic retinopathy. The same instruments used during vitrectomy also may be used to perform laser treatments, remove scar tissue, or to repair a detached retina.<\/p>\n Vitrectomy is usually performed as an outpatient procedure. After surgery, the eye will be treated with eye drops as the surgeon monitors the healing of the eye.<\/p>\n\t Take the first step<\/strong><\/p>\n If you have diabetes, a careful, comprehensive eye examination by one of our diabetic eye specialists is the first step. Our doctors use very specialized technologies – and years of training and experience – to examine your eyes and check for the presence of disease. At your examination, your doctor will personally discuss with you the health of your eyes, how your condition is affecting your vision and what treatment options are available. The bottom line: trust the experts. Insist on Eye Consultants of Pennsylvania.<\/p>\n Retinal Videos<\/p>\n\t\n
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